Be Ready to Discuss Measles and Promote Immunization

 An uptick in recent cases will highlight the need for identifying measles AND preventing future cases with vaccinations.

A common scenario is when an unprotected traveller picks up measles while abroad...then spreads it to nonimmune people back home.

Be alert for symptoms, such as fever, the “three Cs”...cough, coryza (runny nose), and conjunctivitis...and a rash starting on the face.

Recommend isolation, since measles is highly contagious, especially from 4 days before to 4 days after the rash starts.

Explain that 9 out of 10 nonimmune patients will get measles after exposure...and about 1 in 4 or 5 will end up in the hospital with complications (pneumonia, encephalitis, etc).

Be aware, some nonimmune patients may be eligible for postexposure prophylaxis. Giving MMR vaccine within 72 hours of initial exposure or immune globulin within 6 days may help prevent measles or limit severity.

Reassure vaccinated patients that MMR boosters aren’t recommended during a measles outbreak yet. About 97% of people develop lifelong immunity after two doses of a measles vaccine. And if they do get measles, explain it’s usually milder than in unvaccinated patients.

Help ensure your patients are protected.

Children. Continue to recommend two doses of MMR or 12 to 15 months, then at 18 months or anytime up to school entry.

Make sure kids are protected before travelling to an outbreak area or outside of Canada. Recommend kids 12 months or older have two MMR doses at least 4 weeks apart...or one MMR dose for infants 6 to 11 months.

But point out that infants who get MMR before one year of age still need two MORE doses per the usual schedule...instead of two doses total.

Adults born in 1970 or later. Ensure they’ve had at least ONE dose of MMR...or TWO doses at least 4 weeks apart for adults at higher risk of exposure...postsecondary students, healthcare workers, military, and international travellers.

If patients don’t have a record of getting MMR, vaccinate.

Adults born before 1970. These adults are presumed to have natural immunity to measles. But recommend TWO doses at least 4 weeks apart for healthcare workers and military personnel...or one dose for international travellers and postsecondary students.

Use our resource, Vaccine Adherence: Addressing Myths and Hesitancy, to support your discussions and tackle barriers

Key References

  • Health Canada. Measles vaccines: Canadian Immunization Guide. September 8, 2023. (Accessed February 29, 2024).
  • McLean HQ, Fiebelkorn AP, Temte JL, Wallace GS; Centers for Disease Control and Prevention. Prevention of measles, rubella, congenital rubella syndrome, and mumps, 2013: summary recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2013 Jun 14;62(RR-04):1-34.
Pharmacist's Letter Canada. March 2024. No. 400329

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